What is pseudofolliculitis barbae?
An article has recently been published in the journal Jama Dermatology reviewing pseudofolliculitis barbae . It is a dermatological condition that appears after shaving . Although its exact incidence is not known, it is relatively common in people who have curly hair by nature and occurs in up to 60% of black men (other sources point to 94%). It can also rarely affect women.
It is called pseudofolliculitis because it mimics folliculitis , the inflammation of the hair follicles. But in reality, in pseudofolliculitis barbae what happens is that the hairs curl and re-enter the skin or grow under the skin after shaving . According to Ribera et al, it is a process ” characterized by the presence of an acneiform eruption of papules and pustules in the beard due to the penetration of the hairs into the skin . The symptoms vary from minimal discomfort to pain and intense itching in the area, and even wounds and bleeding when eroding the papules with a new shave “.
That is, it presents with small lumps or grains of the color of the skin or red in the shaved areas and sometimes they are filled with pus . They can darken and become scars. A bacterial infection may also appear.
Pseudofolliculitis usually occurs in the beard area, but it can also occur in the armpits, groin, or other shaving or hair-pulling areas. In short, it is what we commonly call “ingrown or ingrown hairs”.
What is the correct way to shave to avoid pseudofolliculitis?
To avoid pseudofolliculitis, the correct way to shave is not to shave. Ribera affirms that “when the hair grows and reaches a length of 10 millimeters, it generally comes out of the inflammatory papule and the process tends to resolve itself spontaneously.” End of the problem, although sometimes it takes months.
But sometimes growing a beard is not a personal or imposed option. So I am going to tell you some tips to shave if you suffer from pseudofolliculitis barbae endorsed by Jama Dermatology and the American Academy of Dermatology.
If you want to shave, you should do it every day. It is better to increase the frequency than to seek a perfect close by spacing out the days of shaving. This is one of the points in which the advice found on the Internet differs the most. In the case of pseudofolliculitis, it has its explanation: letting the hair grow is when it enters the skin instead of coming out. If we shave it frequently, we avoid this problem.
Blade or electric razor?
Regarding whether to use a blade or an electric razor , you can in this case use a razor designed for sensitive skin . It can be helpful as it prevents a close shave. The results published with the use of these methods indicate that ” 72% of individuals with pseudofolliculitis improve by more than 25% after a few weeks of using special razors “, according to Ribera, the electric razor is also useful, which does not cut the hair flush with the skin, if not a few millimeters from the surface.
Of course, if you use blades they have to be very sharp . The use of a single blade razor is recommended. Razors with two or more blades favor transfollicular incarnation because the first blade pulls the hair out and the second cuts it, subsequently causing the hair to retract into the follicle.
The blades should not be reused more than 5 times and should never be used to shave other parts of the body to avoid infection. And in the case of an electric razor, replace the foils and blades as often as recommended in the instructions that come with the razor.
Hair training and avoiding counter-grain
Yes, train your hair . You have read well. The American Association of Dermatology recommends changing the direction of hair growth by using a clean toothbrush to gently brush hair in one direction. Doing this daily will train your beard hair to grow in one direction, which can significantly reduce re-injury.
Shaving against the grain improves shaving and there are people for whom this practice has no consequences. But in the case of pseudofolliculitis we could say that it is a crime. If the previous training advice does not apply, at least this point must be taken into account. It is important to observe the direction of hair growth and keep in mind that not all beards grow in the same direction. Observing the different areas with a mirror can help you get to know your beard. It is also necessary to avoid passing the blade through the same area several times: try to minimize the number of passes .
Another widespread practice is stretching the skin while you shave: this should be avoided in the case of pseudofolliculitis. And we should also avoid pulling or squeezing ingrown hairs. Both of these things increase the chances of new lesions appearing and worsening existing ones. Specifically stretching the skin , can make you cut the hair in another direction to which it grows, encouraging it to ingrow later.
Steps to shave a beard correctly to avoid pseudofolliculitis
Regarding the steps, in the Jama Dermatology article, they first indicate the application of a gentle facial cleanser to remove dead skin cells and reduce bacteria and the number of hairs that curve inward. Then you have to rinse with warm water to remove this cleanser.
It is important to moisten the hair well and not dry shave to eliminate this problem. You can shave after showering as the heat and humidity softens the hair for shaving (there are anti-fog mirrors that can make the task easier). Or you can also apply a clean compress or towel with warm water for 5 minutes.
Then you have to apply shaving cream , even when using an electric shaver. Shaving without foam with pseudofolliculitis is not a good option. It is important to see that your electric shaver is not damaged by shaving cream. It is interesting to look for one that allows the use of the cream because it improves the razor’s lubrication, avoiding irritations. By the way, electric ones are used in circles!
Rushing is not good: let the shaving cream work for a few minutes . Especially if you have a very thick, curly or hard beard. It should be wet to start with and not allowed to dry out. If this happens, we remove it and reapply it. When using a single-blade razor, rinse the blade after each stroke .
When you have finished shaving, rinse off the shaving cream with cold water . Placing a cold compress or towel for five minutes can also help prevent the appearance of pseudofolliculitis. After this, apply a soothing aftershave lotion. Dermatologists recommend using a specially formulated aftershave to reduce the risk of irritated skin. If an aftershave lotion burns or itches, stop using it and try another. The market for these products is booming. It is a matter of trying and relying on medical advice.
The process ends by drying the blade or razor and storing it in a dry and cool place to prevent the proliferation and growth of bacteria. The towels that are used with warm and cold water must be washed from time to time and avoid their use with other people and other areas of the body.
Other shaving options
In the analyzed Jama Dermatology article they mention two: chemical hair removers and laser hair removal . The use of chemical hair removal creams does not ensure that pseudofolliculitis does not occur, but it does work in some people. They are very irritating products and should be used with caution because they can cause permanent skin discoloration.
It may be beneficial to test using a small amount of cream on a small area of skin to see how your skin reacts. In the case of using this method , its daily use is not recommended, but every 3 days minimum.
Laser hair removal can be appropriate and works by destroying the hair at the root, preventing it from growing back. If this method has crossed your mind, it would be interesting for you to consult a dermatologist to help you decide. On many occasions, the laser is the only method and the definitive one to end pseudofolliculitis .
When should I seek medical attention?
The dermatologist is the skin specialist. It seems obvious, but with any questions or problems we should always go to this professional. You will be able to carry out an exhaustive assessment of our skin, determine if this is the problem we have and prescribe medications or creams with corticosteroids or antibiotics to relieve symptoms.
Also, as Jama Dermatology reminds us, they can even issue a report to prove at work that you can’t shave. Ribera and collaborators affirm in their study that “ this pathology can be very problematic for people who need to shave compulsorily . Beards are still not allowed in certain professions and even in some large companies.”
References:
Ludmann, P. (2022). Razor bump remedies for men with darker skin tones. Retrieved June 29, 2022, from the Aad.org website: https://www.aad.org/public/everyday-care/skin-care-basics/hair/razor-bump-remedies
Ogunbiyi, A. (2019). Pseudofolliculitis barbae; current treatment options. Clinical, Cosmetic and Investigational Dermatology, 12, 241–247. DOI:10.2147/CCID.S149250
Patel, T. Se et al. (2022). Pseudofolliculitis beard. JAMA Dermatology (Chicago, Ill.), 158(6), 708. doi:10.1001/jamadermatol.2022.0077
Ribera, M et al. (2010). Pseudofolliculitis barbae. Dermo-syphiliographic Acts, 101(9), 749–757. DOI:10.1016/j.ad.2010.03.011
